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The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about singl

The situation is not helped when proponents of single-payer say things like "there will be no denial of claims." I think there are things to support about single-payer, but it really, truly, I swear to fucking God, has trade-offs, and since it has been sold as not having any honest trade-offs, we can't actually implement the hard parts of single-player. http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-payer-health-care http://www.vox.com/2016/1/17/10784528/bernie-sanders-single-...

VonGuard 10y ago
Yes, there are trade-offs. In my opinion, they are worth the switch, and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." The latter being the single payer option. Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.
- danielweber 10y ago
  > and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered. The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life. NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle. > Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors. Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)
tbihl 10y ago
A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.
- vidarh 10y ago
  Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". And a private system, whose priorities are, like in the US, based on how deep your pockets are. For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator: If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up". If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers). The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.
  - ruste 10y ago
    Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.

VonGuard 10y ago

Yes, there are trade-offs. In my opinion, they are worth the switch, and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." The latter being the single payer option. Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors.

danielweber 10y ago
> and amount to a difference between "choosing which hand to reattach and letting the other go dead," and "No lap-band for you fatty." No, it tends to be a lot of care that isn't worth the cost that gets denied. This is very different from what an American expects, which is that everything they "need" (or what their doctor says they should do) ought to be covered. The lap-band often passes, because it can be a relatively low-cost way to add a bunch of QALYs to a patient's life. NB: I think having care decided on a cost-basis is a pretty good approach, at least to start from, but it is immensely unpopular in the US. On both sides of the aisle. > Anyway, in almost all world single payer systems, rich people can still pay for vanity doctors. Often. Not always. In Canada only recently could a doctor offer the same services the government offered, and that was against the will of the legislature. Their supreme court had to rule on it. https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG) https://en.wikipedia.org/wiki/Chaoulli_v_Quebec_(AG)

tbihl 10y ago

A family friend, who was at the time the chief neurosurgeon of a significant Canadian hospital, pointed out once back in the late 80s, "America will never make single payer work because you won't be able to place a cut off where you stop paying to delay death." And of course it's completely true. The claim that there wouldn't be any "death panels" was of the most damning aspects of the legislative battle, because it proved that no one wanted to let reality in.

vidarh 10y ago
Reality, of course, being that the US has death panels: Insurance providers, so the argument was idiotic to begin with. The difference is that with most socialised systems there are two system in parallel: A public system whose priorities set based on measured impact, rather than by . E.g. in the UK, a separate agency develops guidance independently that measures how treatments affect "quality adjusted life years". And a private system, whose priorities are, like in the US, based on how deep your pockets are. For the vast majority the public system is the only one they use, but about 10% pay for private insurance. In practice this acts like a good indicator: If takeup goes up it means more patients believe NHS care is slipping and makes them feel they need to "top it up". If prices goes up (private insurance here is exceedingly cheap, since most providers are based on you going to the NHS first and then referring you privately if you e.g. don't get to see a specialist within X days) it's an indicator the providers see NHS as deteriorating (causing more claims from their customers). The US could do the same - continue to allow private healthcare, but cover a certain level of treatment via a public system.
- ruste 10y ago
  Except you can sue your insurance provider if they deny you coverage for something that they're obligated to cover. You wouldn't be able to sue the government. Edit: Let me also add this; when you sign up for health insurance you're entering into a contract with the insurer. They have to be up front about what they're providing and it's your obligation to understand what you're buying. With the government you don't get that. You get whatever the vanilla flavour of healthcare coverage is today. There's no contractual obligation, only whatever the government says is right today. You don't get a guarantee. Because there's no contract you can point to, even if you're legally allowed to sue (and I don't think you are.) you won't have a case to stand on.